Dr. Janet Choi Spills the Tea on the Future of Women’s Health Benefits and the Role of the Employer

[00:00:04] Welcome to the High Tea with Grace podcast, where we spill the tea on HIT. Today, I'm honored to welcome Dr. Janet Choi, Chief Medical Officer at Progeny, the first billion-dollar women's health benefits company. Thanks for having me, Grace. It's a sheer delight to be able to start my work week by having this conversation with you. So thank you. Thank you. So let's start by having you tell us about the career path that brought you to Progeny.

[00:00:28] It was a relatively straight with a few kind of side ventures, but not too dramatic. I went from being an OBGYN and did a fellowship in reproductive endocrinology and infertility because I really liked the geeky aspect of how hormones can regulate a woman's body.

[00:00:43] When I graduated from all my training, I went back to where I went to school and did my residency at Columbia University here in New York City and was on faculty for about a dozen years as a reproductive endocrinologist and had the privilege of working actually with one of my current, really loved the opportunity to help so many patients who are struggling to build families, experiencing recurrent loss, facing a new cancer diagnosis and feeling out of control and wanting to have some hope in their life.

[00:01:11] And the promise potentially of building a family in the future. After about a dozen years, I was approached by a private network to open up a private practice with three wonderful colleagues here in Manhattan, CCR New York. The beauty of that was it enabled me to be able to. One of the frustrations that I had working at Columbia is I had wonderful faculty and staff to work with. But because of the way the systems work, I was maybe allowed 10 to 15 minutes per patient session.

[00:01:37] And for something as profoundly complicated and personal as infertility, oftentimes you need 30, 40, 60 or even 90 minutes to meet with somebody. And so the beauty of private practice was I was able to control my schedule more and spend more time per patient. Along that pathway, I also encountered progeny and first learned about progeny from my patients. Prior to that, most doctors just find insurers in general to be onerous and obstacles to them being able to deliver optimal care to their patients.

[00:02:06] But like a requirement sometimes to do peer-to-peer as an author abuse. In contrast with progeny, what really stood out was I had a patient who walked in the door and she was thrilled to bits with her employer because she said, I've been thinking about egg freezing for years, couldn't afford it. And suddenly this January, my employer implemented this new fertility benefit called progeny. And I was like, great, let me figure out all the prerequisites before we can clear you for it. She was like, it's all sorted. My advocate already walked me through the benefits. I'm just here to get started and learn more.

[00:02:36] Wow, you never... I know. And that's the reason why I was like, all right, maybe this is a one-off. I'll just put it in the back of my mind. I'm a little too busy with other things. And then there was a steady stream of patient after patient under the progeny benefit with infertility, single parent by choice, same-sex couples. And again, I'd have a conversation with other carriers, especially if you're not in a heterosexual relationship with proven infertility, you might have to jump through a few loops. And the response from the progeny crowd was, it's all sorted.

[00:03:03] Let's talk about my medical history and my treatment process because I want to have a baby and get on with it. So it made me realize very quickly that progeny was something incredibly new and intended to make the patients' life easier through a really hard time of their life by supporting them financially, making the administrative burden much lighter for them, making the administrative burden lighter for my team as well. My business team was also like, claims processing is really easy with them.

[00:03:30] And then also realizing that it was helping the employers along the way, because again, it wouldn't be uncommon for patients to say, I have progeny. And boy, am I really appreciative of my employer and planning on sticking with them longer because of this benefit. I was asked to join the medical advisory board, was part of the provider network for a few more years, looking for a slight shift in my career trajectory because I'd been in clinical medicine for over 25 years, but wanted to stay in the space of helping women, helping patients.

[00:03:59] And so as progeny grew, they eventually approached me and said, would you be interested in trying something new and doing a full-time CMO job? And everything aligned. And I am delighted to be here and coming up on two years this May. Wow. So fascinating. We are thrilled to learn from you today and hear from all of your experience about what's going on in the space and just how you think about it.

[00:04:23] How has the systemic lack of focus on women's health impacted where we are today, including the ability to optimize health outcomes? And what are some of the opportunities that in the space that we have for change? So I think that one looking at it from a lens of what has been what have been the obstacles historically, it is lack of access.

[00:04:42] Part of the reason why I think Progeny has succeeded and become the leader in this area is prior to our existence, there wasn't the same approach to comprehensive holistic care delivery in a very complicated area of medicine and fertility. And so access to benefits, access to experienced providers, and not just that, because I think we've all had the same experience as a patient. We go to these fantastic physicians, and because of their scheduling and their administrative constraints, they might have 15, 20, 30 minutes with you at most.

[00:05:11] And then you walk out going, wait, I had 20 other questions, but I don't want to bother the doctor, or maybe I will, but they can't answer my questions. Having someone besides your sister, your aunt, your mother-in-law giving you advice, having that patient care advocate hold your hand along the journey should you have questions really helps make the process smoother. And so it's access to the right kind of care and support, integrated support system, access to the right data.

[00:05:38] I think we're all pretty well aware that for many decades, women were excluded from clinical trials. Ostensibly, the FDA did that in the 70s to protect women from potential stratogenic medications that could cause major birth defects should they decide to get pregnant. But then women were missing from all these trials for a few decades before in the 90s, the federal government reversed their decision and said, we should be including women as well as minorities in clinical trials to learn all the various physiologic responses to the medicines, to different disease states and treatments.

[00:06:09] So data, we're catching up on that, making sure access is in place, and then making sure that patients are informed and educated and know where to turn to, to access this kind of care. That makes a ton of sense. And I think a lot of the conversations in the industry too are about increasing investment in the space, increasing opportunities for solutions to just be able to be offered at all. We've seen more of these solutions hit the market in the past few years. Is that kind of helping close this gap as well?

[00:06:37] I think it's actually wonderful that there's been an increasing focus and drive to try to attack various aspects of particularly women's healthcare. I think there are a lot of point solutions in this space that are trying to do an excellent job. I think having spoken to and met with a bunch of employers over the past couple of years, they want to do right by their employees, especially their female employee population.

[00:07:01] They realize the return on investment is huge, loyalty, attracting talent, if they can offer the right comprehensive benefit. And so I think it's important to not just piecemeal offer one solution for this problem, one solution for that, but being able to offer under one umbrella, cohesive women's healthcare benefit solution.

[00:07:21] And so that's where it comes into play where we, I think the benefit of working with a company like Progeny, and again, I'm biased because I work with them, but I really believe in our mission and our goals, is that we've very carefully spent close to a decade, developed a lot of experience taking care of this very complicated area of women's health and family building. So it doesn't just affect women. 40% of infertility is also related to male factors as well.

[00:07:48] I don't want to also exclude individuals like single parents by choice, members of the LGBTQ plus community who need medical support to be able to build a family. But you basically want to have a cohesive solution where not only do you have provisions to support people access to care, advocacy, education, comprehensive benefits for people in the fertility family building space, but along all the other areas that might touch a woman's adult life, especially as they're working. And so that might be preconception support and advice.

[00:08:18] A lot of our members will call up and not even need to see a doctor. They just want to talk to a professional about how do I optimize my health now so that I can try to avoid infertility problems in four to five years when I start trying to have a family. Or if I'm not deciding to have a family, but I'm in my 40s, some people also enter menopause in the late 30s. How do I get the appropriate perimenopause and menopause care so I can continue to be at the top of my game in the workforce?

[00:08:46] Women who have unmet menopause needs, for instance, are oftentimes forced into early retirement or skipping days at work, spending months on end, if not years, doctor shopping to try to find the right solution. In that particular area of women's health care, it's costing employers over a couple of billion dollars per year and lost work days. I'd love to dive more into that. Why is it financially important for employers to be stepping up? You talked about these early retirement and some of the numbers, but I'm interested to hear more about that.

[00:09:13] Why are they stepping up to do this to improve access and coverage for women's health benefits? So I think that what I find very heartening and humanizing is that these HR leads for these employers really want to do right by their employees and figure out how they can best support them so that they are productive contributors to the company they work for, but also can optimize their quality of life and their health long term.

[00:09:37] When we look particularly for the fertility family building space, there's been research showing that when an employer offers a truly comprehensive fertility benefit, it really ratchets up the loyalty of the employees and much more liable to stay with employer long term. It attracts new talent. There was a recent survey where over 60% of surveyed employees said that they would consider switching jobs to an employer that had a more comprehensive fertility benefit.

[00:10:04] And then when you look at areas of menopause, like I said before, yes, the standard medical carrier system does offer access to women well visits, a gynecologic visit, a primary care provider visit. But again, my personal experience has been, I don't know about yours, and I have access to wonderful GYNs in New York City. It takes me about six months to see a GYN for my well person visit.

[00:10:28] And when I'm there, and she's a friend and colleague because she's busily typing into the requisite EMR list, and maybe have about 15 minutes of FaceTime with her.

[00:10:36] So being able to offer access where it's not just checking the box, making sure the member, the patient can get access to provider services and coaching and advocacy services and the benefits that really makes them feel validated with their symptoms and also can steer them to the right treatments so they can be productive at work, be productive at home as well. And how important is it to focus on early action and prevention when supporting women and families?

[00:11:06] It does. I don't, again, I don't have the stats right in front of me. But when I think about this holistically, and this is the reason why I'm really proud of our preconception well women program as well, is what I found frequently in the patients that I encountered in the office, particularly for patients who are interested in egg freezing, because they're like, just join this great employer, I have this great benefit, don't want to have kids for five years, I know how age can affect my egg supply. So I'd like to try to avoid future fertility. I'd love to be able to freeze some of my eggs now because I know they're younger and healthier.

[00:11:34] And then in the discharge appointment, we would talk about things like that smoking, for instance, vaping might actually decrease your egg supply more rapidly. And they're like, I didn't know that. And I'd say that even if you're in a monogamous relationship, you really should be thinking about using barrier protection with intercourse to try to not expose yourself to sexually transmitted infections, because that can actually translate into future infertility.

[00:11:55] And a lot of patients like, I didn't realize that people who are actively trying to get pregnant, something as simple as saying, make sure you're taking prenatal vitamin, taking in enough folic acid to decrease the neural tube defect in your future baby. That can actually translate into, I looked at the cost of a baby born with a spinal cord defect. It's close to about $700,000 lifetime, a million dollars for that one child.

[00:12:19] And so just a simple lifestyle adjustment of making sure to take some extra folic acid while you're trying to conceive a child can actually make a huge difference in cost. Another condition, endometriosis affects about 10% or more of the reproductive age female population. Pretty awful GYN condition and can lead to a lifetime of chronic pain, not just with menstruation, but in between periods.

[00:12:47] Pain that's so debilitating that people are sometimes running to the emergency room for support, taking days off from work might also translate into future infertility. And I just looked at a couple of recent studies where apparently women with endometriosis seem to historically have lower salaries compared to women who don't have the diagnosis and also lower progression in work and are much more liable to take more days off from work or also leave the workforce because of the disability from poorly managed, poorly diagnosed endometriosis.

[00:13:17] So those are just a few examples where I think preventative access, endometriosis you can't cure completely, but if you can supply a woman with the right treatments and tools, you can help them mitigate the symptoms to try to prevent these future issues along the way. Very interesting. I'm wondering as you're sitting in the middle of what's happening in the space, what innovations are exciting you?

[00:13:42] What technologies or innovations or novel approaches are just making you sit back and say that's exciting? And where do you see the industry really heading on that front in the next 10 years plus? So when it comes to innovations, I really do admire what our company and some others are trying to accomplish where again, it's not just let's wait for you to come to the doctor or come to us when you have a disease state or an acute health problem.

[00:14:07] Let's try to capture you early on when you're healthy and talk about the long-term goals 10, 15, 20 years from now. What can we do now to help you educate yourself, learn about your medical and family history and implement, for instance, lifestyle measures to minimize the chances of you at age 30 developing osteoporosis or heart disease when you're 45, 55, 60. So I like the approach there.

[00:14:33] And I love one of the silver linings that doctors talk about of COVID, as horrible as that arrow, was the rapid introduction. It was basically requisite virtual health solutions. And I think that although not all medical care should or can be delivered through a virtual health approach, I think some can be efficiently. And I love the fact that's being integrated much more readily into healthcare for not just women, but for patients across the board.

[00:15:00] Medicine in general is a little bit slow to evolve because they want to make sure their clinical trial, that it's really been proven across multiple populations to be effective and worth the risk and cost. Although not that new, genetic screening for people who need fertility services and need in vitro fertilization, genetic screening of embryos in certain cases, not all can be quite beneficial to try to mitigate some of the disparities that people encounter.

[00:15:24] One example that comes to mind is PGT for genetic diseases, where both partners and a couple trying to have a child have the same genetic disease mutation. One example is sickle cell trait. African-Americans, I think about one in, again, I need to fact check this, but about 10 to 11% or more individuals carry the trait. And if you mate with someone else who has the same mutation, both of you are healthy, but you have a 25% chance of having a baby with that disease.

[00:15:52] With access to genetic screening of your embryos through IVF, the risk of having a baby with sickle cell disease drops to probably under 1%. And so that really translates into not just a healthier family model, but also savings from the employer. Because should you go on to have a baby with sickle cell disease, the cost of supporting that child through young adulthood is close to a million dollars. When we're thinking about the big picture, what's going on in this space?

[00:16:21] What else can businesses, healthcare providers and insurers do together to build a better system for supporting families and supporting women? So I think that's a wonderful question. And maybe this is a little pie in the sky. I do think being able to drive more research in the areas of women's healthcare. I saw a study that was released, I think last winter, where apparently funding for endometriosis or chronic pelvic pain was the funding that was used for erectile dysfunction.

[00:16:49] And I started to like laugh. Oh my gosh. It's sad and it's hysterical at the same time. So more research driven and focused on women and health conditions that affect women either solely or in different ways than it does affect men. More collaboration in a very collegial way between employers, benefit providers, the doctors, nurse practitioners and nurses who are providing services to the patients.

[00:17:15] To figure out how we can more cohesively deliver collaborative, holistic care for each patient who is seeking support. That sounds amazing. It really excites me. Oh, truly. I can only imagine. If you think about it 20 years ago, when you were working as a physician and in this space and as a teacher, could you even imagine where we are now with this? Yeah.

[00:17:37] And I love the fact that there are forces outside of the medical institutions because they're so busy dealing with all of their issues within the hospitals and universities, but there are forces outside. Oftentimes driven by patient advocates, you know, your patient advocate, where people will say, hey, I had this problem like endometriosis or PCOS and there isn't a great solution. I'm going to start a company and let's try to nip that problem in the bud head on. Absolutely. Absolutely.

[00:18:01] My listeners love to hear about what drives women in healthcare technology, what kind of gets them up in the morning, what habits that they have to really thrive in the work that they do each day. It's not easy. So tell us, what are some things that you do that help you work your best and make a difference? I think relatively easy is as a physician and also working for a company like Progeny with such a strong mission and vision.

[00:18:26] It really helps drive me and makes me excited about working with my colleagues and the providers that we work with and the employers and the members. And that's helping people. Again, very simplistic, but I think that it's a huge motivating factor for myself and for my colleagues. What makes me get up in the morning and energizes me is making sure that the minute that I wake up, I try to keep to a pretty regular sleep schedule.

[00:18:51] I'll try to sleep at least seven to eight hours a night if I can because I find that when I get less than that for too many days, I'm off my game. And I work out every morning as mundane as it sounds because that really gets me going. And also trying to balance working really hard during the week and also carving out some time on the weekends, but also making sure that there's at least a day in the week when I have some space where I can remove myself from work to clear my brain.

[00:19:18] Helps me be more creative and energized to come back to work at the start of the week. Oh, I love that. I think obviously we know this culture just wants people to be busy and to just take a day a week at least to just clear your mind, clear your schedule. I'm wondering for your workouts, what are the type of workouts that really help you out? Do you like to run? Do you like yoga? It's highly variable. And again, I think one of the things that was a silver lining of COVID was I started to discover there were these great free workout videos of all sorts on YouTube.

[00:19:47] So it might be a kickboxing video one day. I might just go to the gym or run in the park for another day. In the past few years, some of my colleagues giggle when I mention this. I started doing flying trapeze. I love that. But it actually, the part that I love about that is it's a totally different community of people who I really appreciate. And it's like incorporates play with some pretty strenuous physical activity as well. Oh, that is so cool.

[00:20:13] You are officially at the top of my list in terms of coolest people in healthcare technology. It's a competition, but okay. Oh, that's so funny. So I'm wondering if you could give your younger self a piece of advice looking back to your younger self, what would that be? And it could be personal or it could be professional. Both. I think if I could give my 25, 30-year-old self some advice now. And again, I am still learning. I'm far from perfect. I still get stressed and anxious. Is really try not to sweat it so much.

[00:20:42] There isn't just one path in terms of career life that's ideal. And these twists and turns and lows and highs that are part of the whole life process are actually all the learning processes that really helped me grow. But I think really helped me to become a more meaningful contributor to society.

[00:21:04] So I think if I hadn't gotten so hung up on things that I had to do, getting stressed out about some of the nuances, that's what I'd like to try to tell my younger self and just have more fun with my colleagues, learning from them and working with them side by side. I love that. So thank you. To finish this conversation off, where can our listeners find you online? So online, I have a LinkedIn profile. I think on LinkedIn. I apologize. I don't have the exact handle, but I'm sure if you search me there. Oh yeah, we'll find you. And on Instagram as well.

[00:21:33] I'm based in New York City. So that's where people can find me. That's terrific. Your wavy cup. So this actually, I don't know if you can see, is this lovely teacup from a set that one of my very close friends gave me. And again, like I said earlier, I'm more of an espresso drinker than a tea, although I do have tea in here now. And what I love about this is it reminds me of my friendships because I think a network of friends also is really important to keep us going through life.

[00:22:01] And I also just like how it fits in the palm of my hand. It's such a petite little cup. Like it's a perfect size for just holding it with one hand. I just love it. And I love this concept of friendships and gifting each other and just helping encourage each other. It's just truly inspiring. I think it's incredibly important, not just amongst friends, but again, professionally. Women really do. And I'm not trying to just pay lips to this too.

[00:22:25] I really think it's important that women need to work to continue to support each other, uplift each other for a whole variety of reasons that all of us are facing in the changing climate today. Thank you so much for joining us today. It was awesome learning from you. It was a real pleasure. And thank you so much for having me. Thanks to you folks for joining us too. Check out the High Tea with Grace podcast for more interviews with esteemed guests like Dr. Choi today. Cheers. Like a Girl Media is more than a media network. It's a community.

[00:22:51] We want to meet you and amplify your voice and the voices of outstanding women innovating in healthcare. Interested in starting your own podcast or hosting an event near you? Connect with us online or in person. We're here to support and empower you. Thank you.